BMJ Case Reports 2012; doi:10.1136/bcr.12.2011.5370
  • Unusual presentation of more common disease/injury

Tuberculous meningitis, an unusual presentation in a young lady

  1. Upul Kumara Dharmasena1
  1. 1Department of Acute Medicine, Walsall Healthcare NHS Trust, Walsall, UK
  2. 2The Medical School, Sheffield, UK
  1. Correspondence to Dr Saad Aldeen Saeed, saadsaeed{at}


A 37-year-old Persian-speaking woman presented with epigastric pain, vomiting and non-specific frontal headache. Examination was unremarkable except for an isolated sixth nerve palsy found a few days after admission. Blood results were normal, as was the chest radiograph and the CT scan of the head. Initial cerebrospinal fluid (CSF) analysis revealed a significantly elevated protein level with reduced glucose, as well as CSF lymphocytosis. Tuberculosis (TB) meningitis was considered and she was commenced on anti-TB treatment before confirmation of the diagnosis. A full contact tracing was performed with regular follow-up with TB nurses. When she was seen in the clinic a month later, her symptoms had subsided completely.


  • Competing interests None.

  • Patient consent Obtained.

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